Marshall Medical - Placerville, Ca. 95667

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MARSHALL FOUNDATION DONATION
MARSHALL FOUNDATION & MATHEWSON-BONSER NURSING SCHOLARSHIP FUND
A Celebration of Excellence in Nursing!

To honor the nurse of your choice, at Marshall or elsewhere, simply complete this form. The nurse or nurses that you choose will receive a special recognition letting them know that you appreciate their caring and compassionate ways.
Name 
Address 
City 
State 
Zip 
Phone (Home) 
Phone (Work) 
Email   (to receive confirmation)
Please Note: Bolded fields are required.

 

Please complete the following for up to five nurses. If you have more than five nurses to honor please call us at 530-642-9984 or submit two forms. We also ask that you provide a quote about your nurse. While this is optional, it will help us honor the nurse more appropriately at the event in May.
Nurse's Information Please list people we should inform of this recognition. Also use the space below for a quote about this nurse
Nurse's Name

Amount($) 
 Check here if gift is in memory of this nurse

 

  

 

THIS IS A SECURE TRANSACTION*.

Payment Type: VISA MC
Card Account#  3 digit Security Code: 
Expiration:   Month  Year 
Name of Cardholder, as it appears on the Card:

ALL GIFTS ARE TAX DEDUCTIBLE TO THE EXTENT ALLOWED BY LAW.

 

If you have any questions regarding giving options, please call:
530-642-9984

Karen Good, Executive Director

 

Please check with your attorney or other professional advisor for specific financial benefits to you.

Ask us about Leaving Your Own Legacy in support of "programs that care for people."

 

*This form uses Verisign SSL secure encryption. You may verify this by making sure you have the CLOSED padlock icon showing at the bottom of your browser window. You may click on the Verisign logo shown above to verify Marshall's registration with Verisign.
1050 Marshall Way
 

Marshall Foundation for Community Health . P.O. Box 1996, Placerville, CA 95667 (530)642-9984
Email Address: mfnd@marshallmedical.org



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